Monday, November 3, 2008

It's no secret that I am one of many people out there that finally found a safe, effective & non-addictive medication to treat a rare form of intractable insomnia. My insomnia is a result of metabolic issues combined with your typical life stressors, which makes it difficult to treat and pretty much chronic.

For the past twelve years, I have struggled with various treatments for my insomnia in a desperate attempt to find those illusive zzzzz's. What I didn't know, was that while I was so hyper-focused on falling asleep that I didn't realize that the sleep I was getting was very poor.

After a string of ineffective, short-term medications whose side effects were worse than their cure, a new doctor I was seeing decided to try me on Remeron. Within days, I was sleeping like I had never slept before. I slept heavily those first few weeks, finding it difficult to wake up and get going in the morning. But, after I adjusted I started sleeping normally for the first time in years.

But, I (like many others) made a big mistake when I first started taking Remeron.....I ate. The doctor's will warn you that there is a risk of weight gain (mine said about 6-7 lbs), but what they should tell people is that the risk is actually reality and that most people end up putting on large amounts of weight.

I personally gained about 16 lbs, which, given my frame, is a pretty large weight gain. And, like many others, despite how much I exercised the weight kept piling on.

For weeks and weeks I was tormeted by the weight gain, as I exercised more and more. I tried to change my eating habits by not eating out, watching calories and being more aware of what I was putting in my mouth. But, the fact was that I wasn't a person who ate poorly, but was now a person who could not lose weight.

So, I started taking a hard, scientific look at Remeron and why it causes so many people to gain weight. I read up on the methods of action, the studies that link Remeron to a reduction in stress hormones (specifically cortisol) and how all of that could be connected to what was happening to people's bodies.

Here's what I noticed: I couldn't seem to build and maintain muscle mass. If I took a single day off of exercise, the fat would pile back on. After months of exercise, I had barely made a dent. But, then I also noticed that certain exercises seemed to create a bigger effect than others (more on that later) and that some days I could barely walk down the street because I felt so heavy and others I seemed to move faster and easier.

Not surprisingly, the research on Remeron talks alot about the weight gain, but, specfically, about the change in body composition. On Remeron, people tend to gain this layer of fat, or that's how I describe it. I call it the immovable layer of lard. It comes out of nowhere and is very stubborn about leaving. Walk all you want, hit that eliptical all you want....it won't move. It makes you want to give up on the drug. To hate it. To return to insomnia, if that's what will make the weight go away.

But then I happened upon some like that lead me another link. And, that's when I put together the cortisol + insulin connection.

This is how it goes: Remeron supresses the stress hormone cortisol. This is one of the reasons it helps people sleep. It basically 'powers down' your brain and slows your metabolism a bit. But, more interestingly is the relationship between cortisol and insulin. Apparently, cortisol counteracts insulin. Insulin basically grabs sugar from your bloodstream and stores it as fat. Your body needs cortisol to counteract and balance this effect of insulin, in addition to helping processing lipids (fats) and proteins.

So, as Remeron is supressing your cortisol it is also contributing to some of the effects of high insulin, specifically hypoglycemia or low blood sugar. When people say that can't stop eating carbs on Remercon, this may be why. Unabated, the insulin is grabbing sugar out of your blood, which leads you to think that you are carb depleted. So, you eat more carbs.

That's problem number one.

Problem number two comes from simply supressing cortisol. Because optimal levels of cortisol are neccessary for processing all macronutrients, having too little of it a night could drastically effect your body's conversion of these nutrients into energy. This could cause weight gain and would explain why people gain weight on Remeron so quickly.

That's problem number two.

So, when I rethought all of this, I actually decided to try a little experiment: To eat a 'Zone' diet that focuses on balancing fats, proteins and carbs, to increase my B-Complex vitamins, add Omegas and incorporate more muscle building activities, such as weight training.

The diet gets rid of the carbs that the Remeron are making your body store as fat. The B vitamins help metabolize macronutrients and convert them to energy, omegas can help balance fat levels and muscle building exercise burns glucose and taps your fat reserves.

Three days and I lost 4 lbs.

So, there is hope. I am going to try and keep this up over the next week and see what happens. But, so far there has been a significant difference. And, given that losing ANY weight on Remeron is almost impossible, I am hoping that this actually works.